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Agenda Planning for Change Program Overview & Structure Outcomes Taking it to “the next level”

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It’s All About Increasing Value The Right Thing to Do in Any Payment Methodology Focus on maximizing value delivered to patients Explore strategies that increase value Enter into contracts that share in value created Value = Quality Cost

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Managing Population Health Today: The FFS model Tomorrow: The Value-Based model Care of the individual Payment for each service we provide Predictability! Care of a population Payment based on the quality and efficiency of our care Uncertainty and risk!

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Patient-Centered Medical Home The Key to Success “Patient-centered medical home (PCMH) is a model of care where patients have a direct relationship with a provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the care provided to the patient and arranges for appropriate care with other qualified providers as needed.” NCQA

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There’s No Place Like a “Medical Home” Physician Directed Practice Comprehensive and Coordinated Care Payment for Added Value Enhanced Access Patient Engagement Safety and Quality Treatment of Patient as a “Whole”

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Team Care A “Team Care” model utilizes a team- approach in caring for patients Responsibilities are delegated and shared Each individual in the chain of patient care functions to the highest level of their qualifications.

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Team Care Workflow With a “Team Care” model, the clinical assistant gathers and documents the data. The clinical assistant: - -Takes a competent history - -Presents to the physician - -Remains in the room with the physician and patient - -Completes all documentation of the visit - -Implements the treatment plan - -Gives patient instructions (AVS), ensures understanding, and completes the visit

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Medical History Reason for visit Note template is loaded in the progress note Collect and document the History of Present Illness and ROS

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Team Care Workflow With a “Team Care” model, the clinical assistant gathers and documents the data. The clinical assistant: - -Takes a competent history - -Presents to physician - -Remains in the room with the physician and patient - -Completes all documentation of the visit - -Implements the treatment plan - -Gives patient instructions (AVS), ensures understanding, and completes the visit

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Team Care Workflow The physician (with the assistant still in the room): Confirms the history Performs the physical exam Makes medical management decisions Articulates diagnostic/treatment plan

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Team Care Workflow The physician leaves the exam room of the completed patient. Orders pended by the clinical staff are filed by the physician. The physician signs any prescriptions that are not electronically transmitted. Physician starts the process with the next patient prepped by the other medical assistant

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Team Care Workflow The medical assistant reviews the After Visit Summary with the patient along with any prescriptions or ordered tests. Patient education is given and reviewed. The patient is escorted to the appointment desk by the clinical staff.